HomeMy WebLinkAboutBuilding permit app, page 1All APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
D t 2 I Permit Number:
a e.
� s
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: c� r •fir f
Property Tax ID#: Y�\�®�
Site Plan Name: �� ��Lc0 ilA
Project Name: A �Aflr
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Mechanical Gas Tank — Gas Piping _ Shutters
_ Electric _ Plumbbiiing' 1 , Sprinklers
Total Sq. Ft of Construction:2-
Cost of Construction: $ 1( 0 J
Generator
Sq. Ft. of First Floor:
1 `5
Lot No. Iq
Block No. -1
Windows/Doors
Roof 3 2 Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name kr (A CAS C C),
Ir
n c
Name: CAAGAd CIS,
Company: a-P� �ei�m
W Ifro Chic-�
Address: OA �QMCA i) S
-1�
City: MC
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Zip Code:
Phone No.
E-Mail:--cw�
L
Fax:
Stater
/-�
�rnQll� CCU'!
Address: 'CED 15
City: �- (I�.�
Zip Code. � ��-!
Phone No �� �tlJ�'
State:
Fax-
�'f �`4
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail k:t c��.
1iYw1'lTtCA U •
State or County License C GC,\ 3 3 2 3 `i C/1
If value of construction is 52500 or more, a KtUJKutu Nonce oI l,VnuIt: IIW= IUI11-MuI=u.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
W r" vni in i rwinro nn AMI A7TnF3R1rV R1:FnRE RECORDING vniiR NnTtCF OF COMMENCEMENT."
TT all A w w-
a Ag42 �!/sue"
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor License Holder
STATE �.�q
STATE OF FLORIDA
COUN � OFO U11 C Q
COUNTY OF Palm ���
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of , 20_ by
this — day of , 20_ by
V, Oki - VA
FYI (L
Name of person making statement.
Name of person making statement.
Identification
Personally Known �/ OR Produced Identification
Personally Known V OR Produced
Type of Identification
Type of Identification
Produced
Produced_
is
(Si nature of N y Public- Sta , arjlata Ma Andrea Saiaza
My Commission GG 29660
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(Si ature of Notary P ic- State f Fi
Notary Public State of f
E� Aires 0113012023
Commission No. 2_gil�l9b oPa Sea'/
41 ^ D�AP a 3tasha Andrea Sala
mission No. W y y Commission GG 296
Expires 01130/2023
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
t1;
SEA E
MANGROVECOUNTER
REVIEW
REVIEW
REVIEW
REVIEW
RE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19